Provider Demographics
NPI:1285688168
Name:COLE, MIKA KAMADA (MD,)
Entity Type:Individual
Prefix:DR
First Name:MIKA
Middle Name:KAMADA
Last Name:COLE
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:MISS
Other - First Name:MIKA
Other - Middle Name:MARGARET
Other - Last Name:KAMADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8001 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2628
Mailing Address - Country:US
Mailing Address - Phone:210-930-4555
Mailing Address - Fax:
Practice Address - Street 1:8001 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5713
Practice Address - Country:US
Practice Address - Phone:210-930-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8701207K00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115622604Medicaid
TXB76739Medicare UPIN
TX115622604Medicaid